title: In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography.
abstract: OBJECTIVE
  The aim of this study was to characterize the morphological features of plaque erosion and calcified nodule in patients with acute coronary syndrome (ACS) by optical coherence tomography (OCT).
  
  
  BACKGROUND
  Plaque erosion and calcified nodule have not been systematically investigated in vivo.
  
  
  METHODS
  A total of 126 patients with ACS who had undergone pre-intervention OCT imaging were included. The culprit lesions were classified as plaque rupture (PR), erosion (OCT-erosion), calcified nodule (OCT-CN), or with a new set of diagnostic criteria for OCT.
  
  
  RESULTS
  The incidences of PR, OCT-erosion, and OCT-CN were 43.7%, 31.0%, and 7.9%, respectively. Patients with OCT-erosion were the youngest, compared with those with PR and OCT-CN (53.8 ± 13.1 years vs. 60.6 ± 11.5 years, 65.1 ± 5.0 years, p = 0.005). Compared with patients with PR, presentation with non-ST-segment elevation ACS was more common in patients with OCT-erosion (61.5% vs. 29.1%, p = 0.008) and OCT-CN (100% vs. 29.1%, p < 0.001). The OCT-erosion had a lower frequency of lipid plaque (43.6% vs. 100%, p < 0.001), thicker fibrous cap (169.3 ± 99.1 μm vs. 60.4 ± 16.6 μm, p < 0.001), and smaller lipid arc (202.8 ± 73.6° vs. 275.8 ± 60.4°, p < 0.001) than PR. The diameter stenosis was least severe in OCT-erosion, followed by OCT-CN and PR (55.4 ± 14.7% vs. 66.1 ± 13.5% vs. 68.8 ± 12.9%, p < 0.001).
  
  
  CONCLUSIONS
  Optical coherence tomography is a promising modality for identifying OCT-erosion and OCT-CN in vivo. The OCT-erosion is a frequent finding in patients with ACS, especially in those with non-ST-segment elevation ACS and younger patients. The OCT-CN is the least common etiology for ACS and is more common in older patients. (The Massachusetts General Hospital Optical Coherence Tomography Registry; NCT01110538).
authors.affiliation: Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.forename: Farhad
authors.initials: F
authors.lastname: Abtahian
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Aguirre
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.forename: Stanley
authors.initials: S
authors.lastname: Chia
authors.forename: Harry
authors.initials: H
authors.lastname: Lowe
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.forename: Jinwei
authors.initials: J
authors.lastname: Tian
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Seung-Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Yang-Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: Owen C
authors.initials: OC
authors.lastname: Raffel
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Tomonori
authors.initials: T
authors.lastname: Itoh
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Harold L
authors.initials: HL
authors.lastname: Dauerman
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.forename: Catalin
authors.initials: C
authors.lastname: Toma
authors.forename: Iris
authors.initials: I
authors.lastname: McNulty
authors.forename: Shaosong
authors.initials: S
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.forename: Valentine
authors.initials: V
authors.lastname: Fuster
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.forename: Renu
authors.initials: R
authors.lastname: Virmani
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015203:Reproducibility of Results; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: ACS; ECG; MI; NSTE-ACS; NSTEMI; OCT; SCD; ST-segment elevation myocardial infarction; STEMI; acute coronary syndrome; acute coronary syndrome(s); calcified nodule; electrocardiogram; myocardial infarction; non–ST-segment elevation acute coronary syndrome; non–ST-segment elevation myocardial infarction; optical coherence tomography; plaque erosion; plaque rupture; sudden cardiac death